Provider Demographics
NPI:1245758481
Name:DALTON, EMILY WAYE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WAYE
Last Name:DALTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-1805
Mailing Address - Country:US
Mailing Address - Phone:832-723-8347
Mailing Address - Fax:817-582-4266
Practice Address - Street 1:3204 COLLINSWORTH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6528
Practice Address - Country:US
Practice Address - Phone:832-723-8347
Practice Address - Fax:817-582-4266
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1294961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist